Drug IndexUplizna (inebilizumab-cdon)
Billing
Code: J1823
Description: Inj. inebilizumab-cdon, 1 mg
Unit: 1 MG
Payment: $473.513
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$131,000.00Total Reimbursement:
$142,053.90(ASP: $134,013.11, Margin: $8,040.79)
.
.# Units to bill:
300Dosage & Frequency
Neuromyelitis optica spectrum disorder (NMOSD)
Initial:
• 300mg IV followed by another 300mg IV 2 weeks later
Subsequent:
• 300mg IV every 6 months
Initial:
• 300mg IV followed by another 300mg IV 2 weeks later
Subsequent:
• 300mg IV every 6 months
Billable NDCs
72677-0551-01
Uplizna (HORIZON)
300 MG
75987-0150-03
Uplizna (HORIZON THERAPEUTICS USA, INC.)
300 MG
Prior Authorization
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